In 1987, Masae Torai caught a flight to the United States with 4 million yen in savings to undergo a sex-reassignment operation and fulfill a long-held wish to become male.

Masae Torai, 37, (left) who underwent a female-to-male sex-change operation in the United States, shows a petition to Chieko Nono, senior health and welfare vice minister, at the health ministry in Tokyo.

His wish came true. After being diagnosed as a person with gender identity disorder at a U.S. hospital, Torai, the pen name he has used for several books on transsexualism he has written, underwent surgery at age 23 to remove breasts and lacteal glands.

He returned to Japan and started taking male hormones in a bid to have a body more like that of a man. Two years later, Torai’s ovaries were removed in the U.S.

Although Torai, 37, still needs to periodically inject male hormones to maintain his male features, he said his anguish over his physical state has been surgically cured. His social suffering, however, continues. He still faces difficulties in many aspects of daily life because legally he remains a woman.

“When I renewed my passport a few years ago, I had to explain my situation for 30 minutes in front of other applicants,” he said. “I feel embarrassed, bothered to explain, and often even sorry to confuse other people in every situation I need to show my ID.”

The Family Registration Law stipulates that registrations can be corrected only when “mistakes” are found. Judicial authorities have repeatedly rejected petitions by transsexuals to change their gender registration, saying sexual identity is determined only by sex organs and chromatids. Only one amendment has thus far been approved for a gender identity disorder patient, in 1980, according to Torai.

Last month, Torai and five other transsexuals separately petitioned four family courts in eastern Japan to change their registered genders.

On Monday, Torai and three other transsexuals also petitioned the Health, Labor and Welfare Ministry to allow them to change their registered sex on health and employment insurance documents and public pension papers.

They also requested that the cost of sex-reassignment operations be covered by health insurance and called for administrative measures to prevent employment and other social discrimination toward such people.

Prior to Monday’s petition, Torai told The Japan Times that Japan, where sex-reassignment surgery has already been authorized for people with gender identity disorder, should now move ahead to allow them to legally change their sex.

“Our constitutional right to pursue happiness is being violated,” he said. “Currently, I cannot even marry my girlfriend.”

For him, adolescence was simply a nightmare. “Everyday, I felt that I was growing into an undesired body,” he said. “I hated every aspect of my life, ranging from wearing a girl’s uniform at school to having a high-pitched voice and menstruation.”

In 1996, Saitama Medical School authorized sex-reassignment surgery as a legitimate medical treatment for patients diagnosed with gender identity disorder. Two years later, the first patient underwent female-to-male surgery, and to date, seven patients have undergone sex-reassignment surgery there.

In addition, another received a male-to-female operation at Okayama University Hospital in January.

Many sufferers of the disorder previously underwent such surgery abroad, mainly in the United States — where about 1,000 people had had sex-reassignment operations by 1980 — and Thailand.

According to Toshio Yamauchi, a psychiatrist at Saitama Medical School and head of the Japanese Society of Psychiatry and Neurology’s special committee on gender identity disorder, such surgery is necessary for serious cases.

“Previously, psychiatrists tried to help patients accept their physical sexuality through counseling, but it rarely worked,” he said. “Sex-change operations may still appear extreme or even immoral, but it is often the only solution for patients.”

According to the latest studies, gender identity is probably established in the fetal stage, often regardless of physical or genetic characteristics.

Gender is genetically established at the time of fertilization, but a “hormone shower” must follow to establish gender in a physical and probably psychological sense, during the brain’s development, in accordance with the genetically determined sex, Yamauchi explained.

But fetuses are often supplied with fewer hormones than required or in some cases the hormones of the opposite sex, spawning gender identity disorder, or in extreme cases, birth as a hermaphrodite, he said.

Torai said he believes his disorder was caused by his mother taking steroid hormones to prevent a miscarriage.

A report released by a prominent U.S. psychiatrist in 1985 said that in the U.S., one out of 24,000 to 37,000 men and one out of 103,000 to 150,000 women have gender identity disorder. Saitama Medical School, where about 350 people have so far received counseling and other treatment, estimates there are between 2,200 and 7,000 cases in Japan.

While Yamauchi said he believes the registration law should be amended to allow transsexuals to change their registered gender, he said it would help just a small segment of patients.

“Those who want to completely transform their bodies through surgery account for less than 10 percent of all the patients we have treated, and many others choose to live between the two sexes,” he said.

“Some are still confused over which sex they belong to and face persistent prejudice from the general public, which tends to regard such patients only as sexual perverts.”

Rumiko Miyazaki, a biological male who asked that his real name be withheld, may be a good example. Identifying himself as having gender identity disorder, Miyazaki lives as a woman on Saturdays and teaches politics and economics at a Tokyo high school as a man on weekdays.

Having had no surgery or hormone treatment and having never consulted a psychiatrist, Miyazaki also has a wife and son at home, to whom he plays the role of father on Sundays.

“I feel so much more comfortable living as a woman and can’t wait for Saturday to come around,” said Miyazaki, who is in his 40s. “But even other transsexuals call me a phony GID or just a pervert.”

Yamauchi of Saitama Medical School said it is crucial for society to break through the prevailing “dualism of sexuality,” which tends to ignore the presence of sexual minorities and often dismisses their rights.

“Dualism in sex draws a strict line between two genders and defines those in between only as perverts,” he said. “Such an idea is obsolete from the perspective of medical science, and a society that adheres to that ideal is simply immature and inhumane.”

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